How healthcare fraud occurs and triggers FBI involvement

Healthcare fraud costs the U.S. government billions of dollars every year and beneficiaries must be alert to the possibility of fraudulent activities. Criminals use a variety of ways to obtain patient information they can use in their fraudulent schemes and investigating this kind of activity is a high priority for the FBI.

Stealing information

Healthcare fraud scams involve obtaining a patient’s insurance information in various ways:

• Offering an inducement to the insurance beneficiary to visit a medical clinic or other facilities where the patient provides his or her identity upon signing in

• Obtaining patient information through a free screening; for example, at a health fair

• Providing an inducement for medical personnel to copy patient information and provide it to someone operating a fraud scheme

• Purchase patient information from other fraudsters, such as someone marketing stolen physician billing information

Reviewing and reporting

A patient should carefully review the Explanation of Benefits section the insurance company sends out. This document lists the services and supplies from medical providers. If anything is missing or looks suspicious, the patient should report it to the insurance agency at once.

Investigating healthcare fraud

The Federal Bureau of Investigation (FBI) is the agency responsible for investigating healthcare fraud. All FBI field offices have personnel assigned to this kind of fraud specifically. The agency targets possible perpetrators through the use of task forces and undercover operations. The FBI works with various federal agencies including the Drug Enforcement Administration (DEA), the Internal Revenue Service (IRS), the Health and Human Services Office of Inspector General (HHS-OIG) and state and local agencies. The FBI also works with the public through the Healthcare Fraud Prevention Partnership to help curb healthcare fraud.